Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA.
Department of Veterans Affairs, Office of Geriatrics and Extended Care, Veterans Health Administration, Washington, District of Columbia, USA.
J Am Geriatr Soc. 2021 Aug;69(8):2090-2095. doi: 10.1111/jgs.17180. Epub 2021 May 4.
BACKGROUND/OBJECTIVES: COVID-19 has caused significant morbidity and mortality in nursing homes. Vaccination against SARS-COV-2 holds promise for reduction in COVID-19. This operational analysis describes the proportion of SARS-COV-2 positive tests before, during, and after vaccination.
Retrospective longitudinal cohort analysis from October 1, 2020 until February 14, 2021.
A total of 130 Department of Veterans Affairs (VA) Community Living Centers (CLC), analogous to nursing homes.
Vaccination for SARS-CoV-2.
The primary measure is the proportion of SARS-CoV-2 positive tests among CLC residents. In a pooled analysis of weekly testing and vaccine data, the proportion of positive tests was compared for the unvaccinated, first dose, and second dose. For each CLC, we identified the week in which 50% of CLC residents were vaccinated (index week). The analysis aligned the index week for CLCs and examined the proportion of SARS-CoV-2 positive tests at the CLC level before and after. As a reference, we plotted the proportion of positive tests in nursing homes in the same county as the CLC using publicly reported data.
Within the pooled VA CLCs, the first SARS-CoV-2 vaccine dose was delivered to 50% of CLC residents within 1 week of availability and second dose within 5 weeks. Relative to the index week, the risk ratio of SARS-CoV-2 positive tests in the vaccinated relative to unvaccinated was significantly lower in Week 4 (relative risk 0.37, 95% confidence interval 0.20-0.68). Throughout the study period, the proportion of SARS-CoV-2 positive tests in community nursing homes was higher compared to VA CLC and also declined after vaccine availability.
The proportion of SARS-CoV-2 positive tests significantly declined in VA CLCs 4 weeks after vaccine delivery and continued to decline in vaccinated and unvaccinated residents. The results describe the importance of SARS-CoV-2 surveillance and vaccination in VA nursing home residents.
背景/目的：COVID-19 在养老院造成了重大的发病率和死亡率。接种 SARS-COV-2 疫苗有望降低 COVID-19 的发病率。本操作分析描述了疫苗接种前、期间和之后 SARS-COV-2 阳性检测的比例。
2020 年 10 月 1 日至 2021 年 2 月 14 日的回顾性纵向队列分析。
总共 130 个退伍军人事务部（VA）社区生活中心（CLC），类似于养老院。
接种 SARS-CoV-2 疫苗。
主要测量指标是 CLC 居民中 SARS-CoV-2 阳性检测的比例。在每周检测和疫苗数据的汇总分析中，比较了未接种疫苗、第一剂和第二剂的阳性检测比例。对于每个 CLC，我们确定了 50%的 CLC 居民接种疫苗的周数（索引周）。分析将 CLC 的索引周对齐，并检查之前和之后 CLC 级别的 SARS-CoV-2 阳性检测比例。作为参考，我们使用公开报告的数据绘制了与 CLC 所在同一县的养老院中阳性检测的比例。
在 VA CLC 中，第一剂 SARS-CoV-2 疫苗在上市后 1 周内为 50%的 CLC 居民接种，第二剂在 5 周内接种。与索引周相比，接种疫苗的 CLC 居民中 SARS-CoV-2 阳性检测的风险比在第 4 周显著降低（相对风险 0.37，95%置信区间 0.20-0.68）。在整个研究期间，社区养老院的 SARS-CoV-2 阳性检测比例高于 VA CLC，并且在疫苗供应后也有所下降。
疫苗接种后 4 周，VA CLC 中 SARS-CoV-2 阳性检测的比例显著下降，接种疫苗和未接种疫苗的居民的比例持续下降。结果描述了 SARS-CoV-2 监测和 VA 养老院居民疫苗接种的重要性。
